463 / 1028
P. M.
Days
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s
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Inquest No.
Name
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JI
Re��t
�
M
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19_,
._
A
. �·
Residence
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·
'4-3J
1
1n
c
t�
.u.
Ot-v'L
e
rr-
1-<....
White-�ed-Mrle-Female.
Age_
Years
____
Months
---
Nativity
_____ _ _
_
_
___ ___
_
_
_
_
_
How long in County?
____
P. M.
Days
Married-Single-Widow-Widower.
Occupation
_____ __ _____________
Father's Name
_____________
_
Mother's :Nallle
_____ __________
Estate
:Next Friend
________ _ ______
Place of Death
___ _ ________
_
Date of Death
_ _________ __
Body Found
___
_
Place of Accident
Nature Injuries
_
Canse of
D
eath___A__
q_
�
__?
�
� �
�5
t...l
�,"3
404
(0
�J
Post
Mortem�= ��
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d,,e,�
-
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tftr
ah_
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y\;:
!Yb..-0
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a..J�
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c-;;JI_
«.............. R
_,,
c.o
_,
4
_ _ ___
Names of Turymen
'
-u�
I
··-
�ames of Witnesses
__ __________ _____________________
_
- --
Undertaker
=11:iZ.
-
-
_
-
-
-
Fees Paid
_______
UNKNOWN
Height
Weight
_ ____
_
Hair
_ ___ _
_
Eyes
__
_
Nose
Chin
_ _ _ _ _
_
:Neck
_ _____
Teeth
__
_
Beard
Mustache
_ _
_
_ _ _
_
__________
Scars, �arks, De�r1nit ies, Etc.,
______________________________
_
Clothing __
Contents of Pockets, Etc.,
Remarks:
_
VERDICT:
----
--
- - -- ---
Signed
Coroner.